Determination of At-Risk Pediatric Population in Orthopaedic Fracture Clinic Using Pediatric Adverse Childhood Experiences and Related Life Events Screener.

Background: Adverse Childhood Experiences (ACEs) have been linked to many health issues, including musculoskeletal conditions. Limited data exist on the association between ACEs and fractures in adolescents. This study investigated the prevalence of ACEs in a pediatric fracture clinic and examined whether ACEs were associated with baseline characteristics. By understanding the relationship between ACEs and fractures, we can identify potential risk factors and develop targeted interventions to improve the health and well-being of adolescents. Methods: The questionnaire was administered to new patients upon initial visit to the clinic between September 2022 and September 2023 (n = 213). ACE scores were collapsed into the Adversity Index Score (categories 0, 1-2, 3-4, and ≥5) for use in a logistic regression model with the following independent variables: gender, family structure, race, diabetes, obesity, mental illness, and fracture type. The latter four variables were used because they showed significance in the correlation analysis. Results: Demographic distributions were 65.7% male and 34.3% female and 49.5% African American, 41.5% White, 0.5% Asian, 7.6% "other," and 0.9% did not report race. In total, 64.5% of patients had no ACEs, while 35.5% had at least one ACE, and 7.6% of those experienced at least five types of childhood adversity. Only 4.6% of patients living with a single parent had no ACEs. In t-test and logistic analyses, there were significantly higher ACE scores for female patients or patients with obesity or mental illness than their counterparts. Conclusions: A significant portion of patients had experienced ACE(s) and had one or more comorbidities that increased their ACE scores. This suggested a need for routine screening and implementation of established referral programs to address the negative impact of ACEs on well-being. Future research should investigate prevalence in other pediatric specialty clinics as well as longitudinal outcomes of patients with early identification of ACEs who pursued interventions versus those who did not. Key Concepts: (1)Adverse Childhood Experiences (ACEs) have been linked to various health conditions, so the authors tried to determine prevalence of ACEs in a pediatric outpatient fracture clinic and find out if more ACE events were related to baseline characteristics and/or location of fracture.(2)In t-test and logistic analyses, adolescents with female gender, obesity, or mental illness had significantly higher ACE scores than their counterparts.(3)Identification of ACEs in children allows for early detection and intervention with potential to decrease poor outcomes for future generations. Level of Evidence: Level III, retrospective comparative study.